Papua New Guinea (PNG) could face an upsurge in malaria cases due to overly relaxed attitudes to the use of bednets, health experts warn.
“Sometimes I use it, sometimes I don’t,” Susan Kake, 45, said outside her hut in Masumave, a village of 2,000 largely subsistence farmers in PNG’s remote Eastern Highlands Province. “If I’m going to get it, I’m going to get it.”
The country has made progress in stemming the disease’s spread in the past few years, but such fatalism is worrying.
According to PNG’s National Health Information System, 500-700 people die annually from malaria - the country’s second most common cause of hospital admissions, says the Department of Health.
In 2004 the government intensified its malaria control efforts with support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, launching a five-year campaign in 2009 to provide two insecticide-treated nets (ITNs) per household nationwide free of charge.
Alongside insecticide spraying and anti-malarial medicines, ITNs are one of the most effective interventions to control malaria in the absence of a vaccine, says the World Health Organization (WHO), as they act as physical barriers to mosquitoes, and help reduce their numbers.
“Most areas of the country have received nets at least once,” said Tim Freeman, project manager for Rotarians Against Malaria, a local NGO which has been overseeing bednet distributions since 2010 - in an effort already paying dividends.
A survey conducted in 17 of PNG’s 20 provinces between November 2010 and August 2011 showed that just 6.8 percent of respondents were infected with malaria parasites, compared around 18 percent in a survey two years earlier.
Freeman said 2.7 million nets had been delivered to households over the past three years, and 450,000 to vulnerable groups (mainly pregnant women, schools and prisons).
But unless the nets are properly used, their distribution is meaningless, experts say.
“Bednet distribution is one thing. Ownership is another. There seems to be a gap between ownership and utilization,” Walter Kazadi Mulombo, a scientist studying malaria and other vector-borne diseases for WHO in Port Moresby, told IRIN. “Time and time again we’ve seen this globally. Any relaxation of control measures can result in a resurgence.”
According to a 2012 nationwide survey by the PNG Institute of Medical Research (IMR) , which has been evaluating the campaign, over 80 percent of surveyed households had at least one insecticide treated mosquito net at home, mostly obtained through village-based distribution campaigns, yet fewer than 50 percent of those surveyed reported sleeping under an ITN the night before the survey.
At the same time, many nets were still found in their original packaging, with fewer than 40 percent of respondents sleeping under a mosquito net the night before the survey.
“We found multiple reasons why people did not use their nets, but it was indifference rather than lack of understanding that was a highlight,” said Justin Pulford, head of IMR’s Population Health and Demographic Unit.
Some found the nets too difficult to hang, while others complained it made their sleeping space smaller or too hot.
Net usage was highest among infants and children, but decreased with age, the study found.
Global Fund support
While indifference is one concern, another is the fact that current Global Fund support for the campaign (the National Malaria Control Programme) is due to end in late 2014.
“Historically, what we have seen if intensive malaria control efforts are not followed up or maintained, then malaria rebounds; often with a dramatic increase,” said Pulford.
“We’re certainly in a period when we are experiencing a reduction and we expect that to continue. But we’re all a bit nervous about what will happen at the end of 2014.”
Most bednets last three years, meaning those who have already received a net will need to have them replaced. Treated bednets perform best for the first two years of usage (though how, and how often, they are washed, affects this, studies show).
“The bednet, with a shelf life of 3-4 years, may need a replacement. For that we’ll need money,” WHO’s Mulombo said.
According to WHO, an estimated US$5.1 billion is needed globally every year between 2011 and 2020 to achieve universal access to malaria interventions. At present, only $2.3 billion is available.